SERVICES & TREATMENT

Appendicitis

This page will provide you with information about appendix removal. For further details, please speak to your consultant.

What is the appendix?

The appendix is a pouch that is long and thin in shape, measuring between 5cm and 10cm long. The pouch is attached to the large intestine – the organ where faeces are made.

It is unknown why we still have an appendix and its removal is therefore not harmful.

What is appendicitis?

Appendicitis is when the appendix swells and becomes very painful and uncomfortable.

Pain caused by appendicitis usually begins in the centre of the abdomen (stomach) and it may come and go at random intervals. However, within a few hours this pain usually migrates to the lower right-hand side of the body (where the appendix is situated) and here the pain can become much more severe. At this point the pain experienced is usually constant.

Pain in this area is sometimes intensified by walking, coughing and applying pressure to the area. Other symptoms of appendicitis include nausea, loss of appetite, a high temperature and diarrhoea.

What causes lead to appendicitis?

There is still speculation as to what causes some cases of appendicitis, but the condition usually flares up if a small piece of faeces or swollen lymph node on the bowel wall blocks the entrance to the appendix. If the entrance becomes blocked, this can lead to inflammation and swelling – both of which can lead to an increase in pressure and the eventual bursting of the appendix.

Due to the uncertainty behind what exactly causes appendicitis, there is no known way of preventing the condition.

Who can appendicitis affect?

It can develop at any age but is most common in those aged between 10 and 20, with around 40,000 people admitted to hospital with the condition every year in England. This means around 1/13 of us will develop the condition during our lifetime.

How is appendicitis diagnosed?

The appendix can also be present in different locations depending on the individual, including being hidden behind the liver, in the pelvis or behind the large intestine.

Your consultant will ask questions about your symptoms, examine the abdomen and apply pressure to the region to gauge whether this intensifies the pain.

Most consultants will be able to make a confident diagnosis as to whether you have appendicitis or not. If it is the case you will be sent to hospital for treatment immediately.

Other tests

If the symptoms suffered are atypical of appendicitis, then further tests may be required to confirm the diagnosis. These could include:

A blood test (to check for infection)

A urine test (also to check for infection)

A CT or ultrasound scan (to see if the appendix is swollen)

A pregnancy test for women

With these additional tests it can take a few days for results to come back. If it is suspected that you have appendicitis, then it will probably be advised that you have your appendix removed just in case, to ensure it won’t burst whilst the results are being processed. This does mean that some patients have their appendix removed even if it is healthy.

Some consultants may recommend you wait for 24 hours to see if symptoms improve, worsen or stay the same.

What are the alternatives to emergency surgery?

If appendicitis leads to the formation of an appendix mass (a lump on the appendix) then your consultant may provide you with a course of antibiotics to settle the mass, with an appendectomy appointment being made for a few weeks later.

Antibiotics to treat appendicitis has been sudied but there is not yet enough evidence for it to be classified a viable alternative to surgery.

What will happen during the operation?

The most common treatment for appendicitis is the surgical removal of the appendix. This will be done as soon as possible once the appendix has burst.

The operation is called an appendectomy or appendicectomy and is one of the most common operations in the UK. It has a very impressive success rate. Sometimes surgery will be recommended even if appendicitis has not been confirmed; this is because it is safer to remove the appendix rather than wait in case it does burst.

Keyhole surgery (or laparoscopy)

This is the most common way to perform an appendectomy. It requires a surgeon to make a few small incisions in the abdomen; through these incisions key surgical instruments can be inserted to perform the procedure. Recovery with this procedure is quicker than with other methods.

The instruments inserted through the keyhole incisions include:

A tube to pump gas into the abdomen so that it inflates, allowing the surgeon to see the appendix more clearly and also have more room to perform the operations.

A laparoscope, which is another tube with a light and camera. The camera plays back images of inside the abdomen for the surgeon to observe.

Surgical tools to remove the appendix.

The incisions will be closed with stitches once the appendix has been removed. These stitches will either be dissolvable or be removed 7-10 days later by your GP.

Open surgery

This is another appendectomy method and involves creating one large incision. This is the chosen form of surgery if the appendix has already burst and formed an appendix mass (a lump), if access to the appendix is restricted, if the surgeon is inexperienced with laparoscopic removal or if the patient has already had abdominal surgery.

If widespread peritonitis is present, then open surgery will also be chosen over keyhole.

Stitches will be used to close this incision. They will either be dissolvable or be removed by a GP after the surgery.

Risks and complications

Any risks or complications will be discussed in advance of your treatment with your expert consultant.

Recovery

If keyhole (laparoscopic) surgery is performed then most patients can return home within just a few days of the operation. In some cases this can be as little as 24 hours after the surgery.

With open surgery or additional complications like peritonitis, it can take up to a week for a patient to return home.

It is normal to experience pain and bruising within the first few days. Some patients of keyhole surgery may feel pain in their shoulder as a side effect of the gas used to perform the surgery.

Constipation is also common in recovering appendicitis sufferers. A high-fibre diet and good hydration can help with this; not taking codeine (a type of painkiller) can also help.

A full recovery from an appendectomy is made by most patients within a fortnight. If open surgery was performed then strenuous activity should be avoided for up to six weeks.

References:
EIDO Healthcare Limited - The operation and treatment information on this website is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare.

The information should not replace advice that your relevant health professional would give you.